Some doctors now believe that extreme grief due to the loss of a loved one should be medically classified and treated like any other form of depression. Others argue that grief is a natural (and sometimes, necessary) human emotion and it should not be categorized as an ailment that needs to be corrected by "Happy Pills." I don't know whether grief is a "disorder." I am inclined to say "no." I don't think that our brains, and therefore our lives, are meant to be relentlessly cheerful. I suspect that in the absence of "negative" emotions such as sadness, fear or anger, we would also be lacking in beneficial qualities like empathy and survival skills. We all cope with life's ups and downs in our own ways. Throughout the world social rites and religious rituals are designed to help survivors deal with suffering due to bereavement. Despite that the loss of a loved one affects different people with vastly different levels of trauma; some come to terms with it requiring no third party intervention while others may need prolonged periods of solace, and even professional counseling. Surely, a grieving person is depressed. The question however is whether such depression requires medication and if so, what carefully considered criteria ought to be in place regarding the duration of the condition and the severity of the debilitation.
Grieving the loss of a friend, family or loved one may soon be considered a form of depression. While many doctors acknowledge that grief is a very normal part of losing someone close to us, they also acknowledge that it’s important to deal with that grief.
Speaking to the New York Times one doctor explains why turning grief into a depression diagnosis could end up hurting those people suffering from some for of grief.
“This would pathologize them for behavior previously thought to be normal.” says one doctor.
Opponents to the diagnosis also say to could lead many people with short term grief receiving drug treatments that would normally be unnecessary outside of depression symptoms.
I asked my co-bloggers to weigh in with their opinions on the matter. Unsurprisingly, their responses fall on both sides of the argument.
Joe:
That is interesting. I think I like the idea — grief is a real and sometimes debilitating thing, and recognizing it as a mental health issue could remove stigma from receiving treatment or considering it to be a serious issue (beyond, "sure, you're sad, that's totally normal and good").
Norman:
I agree with Joe on this. Having been close with my father, following my mother's death, I witnessed the toll depression took on him for more than 6 months. It was real. It did not start to abate until, at my insistence, he see his internist to deal with it. Medication did a great deal to reduce the symptoms.
On a less personal note, the matter is one of classification. There are accepted definitions and descriptions of what constitutes a disorder and what constitutes depression. Depression is not made from whole cloth. There are different types of depression, and different degrees of the debilitating effects. There are different causes or triggers, and some of them we understand. There are medications that work – differently for different people, and in varying levels of efficacy.
Grief is not depression and depression is not grief. However, depression can be triggered by trauma and loss, and for short duration and, in my father's case, more than 6 months before being medicated.
Last night I happened to watch the movie, A. I. – Artificial Intelligence, a film by Steven Spielberg. The plot direction was established, very early, by showing a mother who is grieving over the loss of her child. The grieving is obsessive and consumes the mother's entire life. An advanced android child is created as a replacement. Interesting movie.
Prasad:
Yikes. I remember once treating grief as a reductio of the idea that terminal cancer patients were clinically depressed something like a quarter of the time and ought to be treated for it. ( I'm D in the comments).
I think this is basically what happens when you combine the idea that the brain is an organ like any other (it is an organ of course, that's fine) with the idea that it's determinative of proper function in any body part to see if the patient/society is happy with it. I think that's a horrible confusion, especially when dealing with mental disorders. Whatever the appropriate proper functioning of a brain looks like, it isn't to make you happy independent of what's going on in your life. The problem is hardly mitigated by stipulating that you'll medicalize only some "small" (but always steadily growing – consider the related case of ADD and ritalin) fraction of cases out in the tail. But what do I know…hook up all grieving relatives to the experience machine.
Anna:
As the article says, at stake is a lot of money. Please consider tying in a related, current topic about a DSM-V definition that moves in the opposite direction– declinicalizing behavior– through the narrowed definition of "Autism." Leave aside the cost of medications to treat various symptoms or therapeutic behavioral services such as ABA, speech therapy, occupational therapy. Also at stake is whether an individual will qualify for state funding lifelong developmental services (supported housing, occupational training and supported employment, respite funding for family caregivers) without which the individual and his/her family may be in dire straits, regardless of whether the appropriate diagnosis is "Autism" or "Pervasive Developmental Disorder- NOS." In my ideal world, all treatment or services are simply available to everyone who needs and wants them, regardless of diagnosis, but in all the bureaucracies of the world, from insurance companies to schools to government social services, getting anything depends on being able to submit the right name/code.
The same is true of depression/grief/any other form of mental state. Someone who is not functioning or very unhappy about his or her unhappiness should be able to fall upon the range of treatments available for mood disorders, from talk therapy to medication, regardless of whether the cause is "major depressive disorder" or "dysthymia," or "grief."
There are many forces, or at least, the one, very powerful force of the pharmaceutical industry, which pushes in the direction of over-treatment, or at least over-medication and too little coverage for non-pharmaceutical treatments. But there are also many barriers to treatment, and if a condition name is what it requires for a very unhappy person to get the help he wants or needs after a profound personal loss, then give him the name grief.
Norman:
Anna hit the nail on its many heads. The issue of depression associated with grieving is more than a matter of classification and definition. I wish it were simply a matter of definition. At the core of the matter is, in significant part, a pharmaceutical industry that maximizes production and profit, without sufficient monitoring, moderation, and modification of dose. Beyond that, there is a name game being played in order to obtain treatment. For example, insurance does not cover PTSD, for the most part. However, to look at the diagnostic codes for reimbursement, one would conclude that everybody in the country who seeks therapy suffers from generalized anxiety disorder and nothing else. This might not reflect, accurately, the frequency and distribution of various disorders, but it enables more people to find treatment and other services.
Getting back to the narrow issue of definition and classification, few of the public understand that one of the primary functions of the DSM is research. One cannot conduct research and publish findings unless there is an agreement on the definition of variables, states, and standards. Electrical engineering, metallurgy, biochemistry, and particle physics have these worked out reasonably well – psycho-pharmacology, psychiatry, psychology, and psychotherapy not so much. However, the current DSM-IV TR is a vast improvement over the earlier collections of 'mushy' generalities.
It's difficult (though not impossible) to have a productive debate in a public forum on the issues in all their complexities. Say the words 'mental disorders,' and you get reactions that range from great compassion to great denial – "There was no such thing as PTSD when I was in the Army 50 years ago." Say the word 'drugs' and powerful emotional reactions come to the surface and find vocal expressions like 'miracle drug', 'saved my life', 'nearly killed me', 'big pharma conspiracies', 'get the country hooked', 'my child will die without it', 'over medicated', and on and on.
I've resisted conspiracy theories for most of my life. The recent decline in breast cancers, resulting from the sharp curtailing of hormone replacement therapies, has changed my mind. The decades long research and writings of Barbara Seaman, and others, exposed the complicity of Big Pharma and the AMA.
Dean:
I experience grief not so much as a medical condition, but as a phase of life involving among other things the acknowledgment of absolute loss, so it's hard for me to imagine viewing grief per se as a disorder. Obviously, phases of life can trigger disorders, too.
Sujatha:
Earlier, I used to think that it wouldn't have been such a big deal to use anti-depressants as a crutch, but after reading Robert Whitaker's 'Anatomy of an Epidemic', and reading about irreversible alterations in brain chemistry as one begins to use such drugs, I'm not so sure about even seemingly benign and short term use.
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